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DIAGNOSA GIZI
TERM AND DEFINI TI O N DOMAIN INTAKE
DIAN HANDAYANI

Nutrition Diagnosis Domains and Terms

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Nutrition Diagnosis and Terms, 2013

75

Sumber:(American Dietetic Association 2011; American Dietetic Association 2013)

Energy Balance (1)

Kondisi riil ataupun hasil perkiraan terhadap perubahan keseimbangan energy (Kcal)

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Class :Energy balance (3)

Term Number NI 1.1 NI 1.2 NI 1.3 NI 1.4 NI 1.5
NI-1.6 NI-1.7

Nutrition Diagnostic Term Unused Increased energy expenditure Unused Inadequate energy intake Excessive energy intake
Predicted sub optimal energy Intake Predicted excessive energy intake

INCREASED ENERGY EXPENDITURE / Peningkatan kebutuhan energi (NI-1.2)

Definisi Resting metabolic rate (RMR) lebih dari perkiraan kebutuhan (energy expenditure) untuk perubahan body composition, medications, endocrine, neurologic, or genetic. Note: RMR is the sum of metabolic processes of active cell mass related to the maintenance of normal body functions and regulatory balance during rest. Etiologi Physiological causes increasing nutrient needs due to anabolism, growth, maintenance of body temperature Aktivitas fisik atau perpindahan fisik, baik disengaja/tidak

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INCREASED ENERGY EXPENDITURE / Peningkatan kebutuhan energi (NI-1.2)

Sign/symptom: Anthropometric: Penurunan BB yang tidak diinginkan: 10% in 6 months, 5% in 1 month (adults and pediatrics) and > 2% in 1 week (pediatrics) Gagal tumbuh, pertumbuhan kurang dari yang seharusnya Peningkatan proporsi lean body mass Clinical finding: Demam Pengukuran RMR > estimated or expected RMR Dietary: Peningkatan aktivitas fisik, e.g., atlit endurance Client History: Keadaan yang ebrhubungan dengan diagnosa/pengobatan, e.g., Parkinsons disease, cerebral palsy, Alzheimers disease, cystic fibrosis, chronic obstructive pulmonary disease (COPD) Pengobatan di atas meningkatkan kebutuhan energi

NI 1.3 Hypometabolism
Dihilangkan pada IDNT edisi 3 (2011) Rationate : It was determined that this is not a

nutrition diagnosis

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INADEQUATE* ENERGY INTAKE / Ketidakcukupan intake energi (NI-1.4)**

Definisi Intake energi yang kurang dari kebutuhan (energy expenditure), standart referensi, atau rekomendasi berdasarkan kebutuhan fisiologis. Catatan: diagnosa gizi dapat tidak sesuai apabila tujuan untuk menurunkan BB, selama perawatan end-of-life care, awal pemberian EN/PN, atau kondisi stres akut (e.g., surgery, organ failure). Apabila memungkinkan, data intake zat gizi diperhatikan digabungkan bersamaan dengan data klinis, biokimia, antropometri, diagnosa gizi, atau faktor lain termasuk diet untuk menyediakan pengkajian data yang valid berdasarkan evidens secara keseluruhan.

*If a synonym, or alternate word with the same meaning, for the term inadequate is helpful or needed, an approved alternate is the word suboptimal. ** Revisi Diagnosa pada edisi 2011

INADEQUATE* ENERGY INTAKE / Ketidakcukupan intake energi (NI-1.4)**

Etiologi Penyebab patologis atau fisiologis yang dapat menyebabkan peningkatan kebutuhan energi, e.g., peningkatan kebutuhan zat gizi karena penyakit katabolik yang berkepanajangan Kurangnya akses terhadap makanan, e.g., keterbatasan ekonomi, budaya, atau pantangan makanan untuk anak/ibu hamil/menyusui, lansia Kurangnya pengetahuan terhait gizi dan makanan Penyebab psikologis, e.g., depresi atau gangguan makan

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INADEQUATE* ENERGY INTAKE / Ketidakcukupan intake energi (NI-1.4)**

Sign/symptoms: Clinical: Gagal tumbuh/pertumbuhan kurang dari yang seharusnya, kegagalan mempertahankan berat badan yang seharusnya Poor dentition Dietary: Intake energi kurang dari yang kebutuhan Pembatasan atau menghindari makanan tinggi energi Pantangan makanan, atau kurang tertarik terhadap makanan Ketidakmampuan mengkonsumsi makanan Inatake NE/NPE yang kurang dari kebutuhan Client History : Konsumsi berlebih alkohol atau obat yang dapat menekan nafsu makan Keadaan yang berhubungan dengan diagnosis/pengobatan, e.g., mental illness, eating disorders, dementia, alcoholism, substance abuse, and acute or chronic pain management Pengobatan yang dapat menghilangkan nafsu makan

EXCESSIVE ENERGY INTAKE / Kelebihan intake energi (NI-1.5)

Definisi Intake energi (e.g., oral, EN/PN, IV, medications) yang melebihi (energy expenditure) kebutuhan, standart referensi , atau rekomendasi berdasarkan kebutuhan fisiologis. Diagnosa dapat tidak sesuai apabila mengharapkan peningkatan BB. Etiologi Kepercayaan/sikap yang salah terhadap makanan/gizi Pengetahuan yang kurang tentang makanan/gizi Kurangnya akses terhadap makanan yang sehat Kurangnya nilai/keinginan untuk mengubah kebiasaan Pengobatan yang dapat meningkatkan nafsu makan, e.g., steroids, antidepressants Overfeeding of parenteral/enteral nutrition (PN/EN) Tidak ada keinginan untuk menurunkan intake energi Ketidakmampuan menyesuaikan intake energi dengan penurunan metabolisme (e.g., penuaan, mantan atlit yang sudah tidak aktif berlatih lagi) Ketidakmampuan menyesuaikan intake energi karena pembatasan mobilitas karena recovery from injury, surgical prosedur, others

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EXCESSIVE ENERGY INTAKE / Kelebihan intake energi (NI-1.5)

Sign/symptoms Biochemical: Ketidaknormalan fungsi liver setelah paparan perkepanjangan (3-6 weeks) Respiratory quotient > 1,0 Anthropometric: % Body fat > 25% for men and > 32% for women BMI > 23 (adults), BMI > 95th percentile (pediatrics) Weight gain Clinical: Peningkatan penimbunan lemak Peningkatan respiratory rate Dietary: Intake makanan densitas energi tinggi, atau porsi besar/frekuensi sering EN/PN lebih dari kebutuhan

Tambahan diagnosa class : energy balance (IDNT 2011)

Predicted sub-optimal energy intake / Prediksi

intake energy yang tidak optimal (NI-1.6)**

Predicted excessive energy intake / Prediksi

kelebihan intake energi (NI-1.7)**

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Class: Oral or Nutrition Support Intake (NI-2) - 9

Term Number NI 2.1 NI 2.2 NI 2.3 NI 2.4 NI 2.5 Nutrition Diagnostic Term Inadequate oral food/ beverage intake Excessive oral food/ beverage intake Inadequate intake from enteral/ parenteral nutrition Excessive intake from enteral/ parenteral nutrition Less than optimal enteral nutrition of enteral/ parenteral nutrition

Class: Oral or Nutrition Support Intake (NI-2) - 9

Term Number NI 2.6 NI 2.7 NI 2.8 NI 2.9 Nutrition Diagnostic Term
Inadequate parenteral nutrition infusion Excessive parenteral nutrition infusion Less than optimal parenteral nutrition Limited food acceptance

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INADEQUATE* ORAL INTAKE / Ketidakcukupan intake oral (NI-2.1)**

Definisi Intake makanan/minuman per oral yang kurang dari standar referensi atau rekomendasi kebutuhan fisiologis. Diagnosa gizi dapat tidak sesuai apabila tujuan menurunkan BB, selama perawatan end-of-life care, inisiasi pemberian makanan atau selama dikombinasi dengan terapi oral/EN/PN. Apabila memungkinkan, intake zat gizi dipertimbangkan dengan memperhatikan data klinis, biokimia, antropometri, diagnosa medis, status klinis dan faktor lain termasuk diet untuk menyediakan pengkajian status gizi yang valid berdasarkan evidens secara keseluruhan. Catatan: Diagnosa ini tidak termasuk intake via oroenteric tube.

INADEQUATE* ORAL INTAKE / Ketidakcukupan intake oral (NI-2.1)**

Etiologi Penyebab fisiologis, e.g., peningkatan kebutuhan zat gizi karena penyakit infeksi yang berkepanjangan Kurangnya akses terhadap makanan, e.g., keterbatasan ekonomi, budaya, atau pantangan makanan untuk anak/ibu hamil/menyusui, lansia Kurangnya pengetahuan terhait gizi dan makanan Penyebab psikologis, e.g., depresi atau gangguan makan Sign/symptoms: Anthropometric: Weight loss, pertumbuhan kurang dari yang seharusnya Clinical: Kulit kering, membran mukosa kering, turgor kulit rendah Clinical evidence of vitamin/mineral deficiency

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INADEQUATE* ORAL INTAKE / Ketidakcukupan intake oral (NI-2.1)**

Dietary: Intake energi dan protein kurang dari kebutuhan Keterbatasan ekonomi yang membatasi ketersediaan pangan Anorexia, nausea, or vomiting Penurunan nafsu makan/indera perasa Limited food/beverage intake inconsistent with nutrition reference standards for type, variety, diet quality Inappropriate reliance on foods, food groups, supplements or nutrition support Client History : Keadaan yang berhubungan dengan diagnosa/pengobatan penyakit katabolik , e.g. AIDS, TB, anorexia nervosa, sepsis or infection from recent surgery, depression, acute or chronic pain, developmental disability, sensory processing issues, prematurity, longterm nutrition support, chronic disease. Malabsorpsi protein atau zat gizi lain Konsumsi berlebih alkohol atau obat yang dapat menekan nafsu makan Pengobatan yang dapat menghilangkan nafsu makan

EXCESSIVE ORAL INTAKE / Kelebihan intake oral (NI-2.2)

Definisi Intake makanan/minuman per oral yang melebihi kebutuhan (estimated energy intake), standart referensi atau rekomendasi berdasarkan kebutuhan fisiologis. Catatan: dapat tidak sesuai apabila mengharapkan peningkatan BB. Diagnosa ini

tidak termasuk intake via oroenteric tube.

Etiologi Kepercayaan/sikap yang salah terhadap makanan/gizi Pengetahuan yang kurang tentang makanan/gizi Kurangnya akses terhadap makanan yang sehat Kurangnya nilai/keinginan untuk mengubah kebiasaan Ketidakmampuan untuk membatasi/menolak makanan Kurangnya perencanaan terhadap pembelian dan penyiapan makanan, Kurangnya kontrol terhadap nafsu makan Pengobatan yang dapat meningkatkan nafsu makan, e.g., steroids, antidepressants
Psychological causes such as depression and disordered eating

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EXCESSIVE ORAL INTAKE / Kelebihan intake oral (NI-2.2)

Etiologi (lanjutan): Tidak ada keinginan untuk menurunkan intake energi Decreased ability to consume sufficient energy, e.g., increased nutrient needs due to prolonged catabolic illness Limited food acceptance due to physiological or behavioral issues, aversion, or harmful beliefs/attitudes Sign/symptoms: Anthropometric: Penambahan berat badan tidak terkontrol Dietary: Intake makanan tinggi densitas energi (juice, soda, or alcohol) Intake makanan/minuman denagn porsi besar Binge eating patterns Sering mengkonsumsi makanan fast food or restaurant dengan porsi besar Client History : Keadaan yang berhubungan dengan diagnosa/pengobatan e.g., obesity, overweight, or metabolic syndrome, depression, anxiety disorder

INADEQUATE* ENTERAL NUTRITION INFUSION / Ketidakcukupan infus makanan enteral (NI-2.3)**

Definisi Pemberian nutrisi enteral yang lebih rendah standart referensi, atau rekomendasi berdasarkan kebutuhan fisiologis. Catatan : 1. Istilah ini tidak cocok bila pasien sedang diterapi untuk menurunkan berat badan, pada periode akhir masa perawatan /during end-of-life care, saat dimulai inisiasi makanan lagi setelah fase stress proses pembedahan dan kegagalan fungsi organ. 2. Apabila memungkinkan, gabunngkan data asupan makanan ini dengan mempertimbangkan data clinic, biokimia, antropometri dan diagnosa medis, status klinis atau factor lain yang dapat menunjang proses assesment yang valid..

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INADEQUATE* ENTERAL NUTRITION INFUSION / Ketidakcukupan infus makanan enteral (NI-2.3)**

Etiologi Perubahan absorpsi/metabolisme zat gizi, e.g., medications Pengetahuan yang kurang tentang gizi/makanan, kesalahan formula/formulasi yang diberikan, e.g., wrong enteral feeding, missing component of EN Kurangnya kerjasama atau ketidaksesuaian pemberian EN Peningkatan kebutuhan zat gizi, e.g., accelerated growth, wound healing, chronic infection, multiple fractures Intoleransi terhadap EN Volum infus NE kurang/jadwal terputus

INADEQUATE* ENTERAL NUTRITION INFUSION / Ketidakcukupan makanan enteral (NI-2.3)**

Sign/symptoms Biochemical : Metabolic cart/indirect calorimetry measurement, e.g., respiratory quotient < 0.7 Vitamin/mineral abnormalities: Calcium < 9.2 mg/dL (2.3 mmol/L), Vitamin K abnormal international normalized ratio (INR), Copper < 70 g/dL (11 mol/L), Zinc < 78 g/dL (12 mol/L), Iron < 50 g/dL(nmol/L); iron-binding capacity < 250 g/dL (44.8 mol/L) Anthropometric: Gagal tumbuh, Penambahan BB ibu hamil kurang dari yang seharusnya Kehilangan berat badan yang tidak direncanakan 5% in 1 month or 10% in 6 months in adults (bukan karena retensi cairan) Penurunan BB pada bayi/anak Underweight (BMI < 18.5)

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INADEQUATE* ENTERAL NUTRITION INFUSION / Ketidakcukupan intake makanan enteral (NI-2.3)**

Clinical: Adanya tanda-tanda klinis defisiensi vitamin/mineral (e.g., hair loss, bleeding gums, pale nail beds, neurologic changes) Adanya tanda-tanda dehydrasi , e.g., mukosa membran kering, turgor kulit rendah Kehilangan integritas kulit, penyembuhan luka terhambat, or pressure ulcers Kehilangan masa otot/lemak subcutaneous Nausea, vomiting, diarrhea Dietary: Volume NE/NPE kurang dari kebutuhan Client History : Keadaan yang berhubungan dengan diagnosa/pengobatan, e.g., intestinal resection, Crohns disease, HIV/AIDS, burns, pre-term birth, malnutrition Kesalahan posisi feeding tube or venous access Perubahan aktivitas fisik

EXCESSIVE ENTERAL NUTRITION INFUSION/ Kelebihan infus Makanan Enteral (NI-2.4)**

Definisi Infus Enteral menyediakan energi yang lebih besar daripada standart referensi atau rekomendasi berdasarkan kebutuhan fisiologis. Etiologi Penyebab fisiologis, e.g., penurunan kebutuhan karena penurunan aktivitas dengan adanya penyakit kritis/kegagalan organ Purangnya pengetahuan tentang makanan/gizi pada pasien/keluarga/petugas kesehatan

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EXCESSIVE ENTERAL NUTRITION INFUSION/ Kelebihan infus Makanan Enteral (NI-2.4)**

Sign/symptoms:

Biochemical : Peningkatan rasio BUN : creatinine ratio (protein) Hyperglycemia (carbohydrate) Hypercapnia Peningkatan enzim liver
Anthropometric: Peningkatan BB Clinical: Edema karena kelebihan pemberian cairan

EXCESSIVE ENTERAL NUTRITION INFUSION/ Kelebihan infus Makanan Enteral (NI-2.4)**

Dietary: Estimated intake from enteral nutrients that is consistently more than recommended intake for carbohydrate, protein, and fatespecially relate to patient/clients ability to consume an oral diet that meets needs at this point in time. Client History: Menggunakan obat yang dapat menurunkan kebutuhan energi atau menghambat metabolisme energy, protein, fat, or fl uid. Unrealistic expectations of weight gain or ideal weight

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Less than optimal enteral nutrition / Makanan enteral yang kurang optimal (NI-2.5)**
Definisi Enteral infusion that provides either fewer or more calories and/or nutrients or is of the wrong composition or type, enteral nutrition that is not warranted because the patient/client is able to tolerate an enteral intake, or is unsafe because of the potential for sepsis or other complications. Etiologi Physiological causes, e.g., improvement in patient/client status, allowing return to total or partial oral diet; changes in the course of disease resulting in changes in nutrient requirements Product or knowledge deficit on the part of the caregiver or clinician End-of-life care if patient/client or family do not desire nutrition support

Less than optimal enteral nutrition / Makanan enteral yang kurang optimal (NI-2.5)**
Biochemical: Abnormal levels of markers specific for various nutrients, e.g., hyperphosphatemia in patient/client receiving feedings with a high phosphorus content, hypokalemia in patient/client receiving feedings with low potassium content Anthropometric: Weight gain in excess of lean tissue accretion Weight loss Clinical Edema with excess fl uid administration Loss of subcutaneous fat and muscle stores Resolving or improved GI function Conditions associated with a diagnosis or treatment, e.g., major elective surgery, trauma, burns, head and neck cancer, and critically ill patients, acute lung injury, acute respiratory distress syndrome, treatments/therapy requiring interruption of infusion, transfer of nutrition care to a new setting or level of care, end of life care.

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Less than optimal enteral nutrition / Makanan enteral yang kurang optimal (NI-2.5)**
Dietary: Documented intake from enteral or parenteral nutrients that is consistently more or less than recommended intake for carbohydrate, protein, and/or fat especially related to patient/clients ability to consume an oral diet that meets needs at this point in time Documented intake of other nutrients that is consistently more or less than recommended Nausea, vomiting, diarrhea, high gastric residual volume Formula composition or type that is inconsistent with evidence-based practice Client History History of enteral or parenteral nutrition intolerance Verbalizations or written responses that are inaccurate or incomplete

Tambahan diagnosa class : energy balance (IDNT 2011)

Inadequate* parenteral nutrition infusion (NI-

2.6)** Excessive parenteral nutrition infusion (NI-2.7)** Less than optimal parenteral nutrition (NI-2.8)** Limited food acceptance / keterbatasan penerimaan makanan (NI-2.9)**

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Class: Fluid Intake (3)

Term Number NI 3.1 NI 3.2 Nutrition Diagnostic Term Inadequate fluid intake Excessive fluid intake

INADEQUATE FLUID INTAKE / Ketidakcukupan intake cairan (NI-3.1)**

Definisi Lower intake of fluid-containing foods or substances compared to established reference standards or recommendations based on physiological needs.
Note: Whenever possible, nutrient intake data should be considered in

combination with clinical, biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors as well as diet to provide a valid assessment of nutritional status based on a totality of the evidence.

Etiologi Physiological causes, e.g., increased fluid needs due to climate/temperature change; increased exercise or conditions leading to increased fluid losses; fever causing increased insensible losses, decreased thirst sensation, use of drugs that reduce thirst Lack of access to fluid, e.g., economic constraints, cultural or religious practices, unable to access fluid independently such as elderly or children Food- and nutrition-related knowledge deficit Psychological causes, e.g., depression or disordered eating; dementia resulting in decreased recognition of thirst

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INADEQUATE* FLUID INTAKE / Ketidakcukupan intake cairan (NI-3.1)**

Biochemical : Plasma or serum osmolality greater than 290 mOsm/kg BUN, Na Anthropometric: Acute weight loss Clinical Findings Dry skin and mucous membranes, poor skin turgor Urine output <30 mL/hr

INADEQUATE FLUID INTAKE / Ketidakcukupan intake cairan (NI-3.1)**

Dietary: Insufficient intake of fluid compared to requirements (e.g., per body surface area) Thirst Difficulty swallowing Client History Conditions associated with a diagnosis or treatment, e.g., Alzheimers disease or other dementia resulting in decreased recognition of thirst, diarrhea Use of drugs that reduce thirst

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EXCESSIVE FLUID INTAKE / Kelebihan intake cairan (NI-3.2)

Definisi Higher intake of fl uid compared to established reference standards or recommendations based on physiological needs. Etiologi Physiological causes, e.g., decreased fl uid losses due to kidney, liver or cardiac failure; diminished water and sodium losses due to changes in exercise or climate, syndrome of inappropriate antidiuretic hormone (SIADH) Food- and nutrition-related knowledge defi cit Psychological causes, e.g., depression or disordered eating

EXCESSIVE FLUID INTAKE / Kelebihan intake cairan (NI-3.2)

Biochemical Data, Medical Tests and Procedures Lowered plasma osmolarity (270-280 mOsm/kg), only if positive fluid balance is in excess of positive sodium balance Decreased serum sodium in SIADH Anthropometric: Weight gain Physical Examination Findings Edema in the skin of the legs, sacral area, or diffusely; weeping of fluids from lower legs Ascites Pulmonary edema as evidenced by shortness of breath; orthopnea; crackles or rales

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EXCESSIVE FLUID INTAKE / Kelebihan intake cairan (NI-3.2)

Dietary: Excessive intake of fluid compared to requirements (e.g., per body surface area) Excessive salt intake Client History Conditions associated with a diagnosis or treatment, e.g., end-stage renal disease, nephrotic syndrome, heart failure, or liver disease Nausea, vomiting, anorexia, headache, muscle spasms, convulsions, coma (SIADH) Shortness of breath or dyspnea with exertion or at rest Providing medications in large amounts of fl uid Use of drugs that impair fl uid excretion

Class: Bioactive substance (4)

Term Number NI 4.1 NI 4.2 NI 4.3 Nutrition Diagnostic Term Inadequate bioactive substance intake Excessive bioactive substance intake Excessive alcohol intake

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SUBOPTIMAL* BIOACTIVE SUBSTANCE INTAKE / Intake komponen bioaktif tidak optimal (NI-4.1)**
Definisi Lower intake of bioactive substances compared to established reference standards or recommendations based on physiological needs. Note: Bioactive Substances are not included as part of the Dietary Reference Intakes, and therefore there are no established minimum requirements or tolerable upper limits. However, RDs can assess whether estimated intakes are adequate or excessive using the patient/client goal or nutrition prescription for comparison. Working definition of bioactive substancesphysiologically active components of foods that may offer health benefits beyond traditional macro- or micro-nutrient requirements. There is not scientific consensus about a definition for bioactive substances/components. Etiologi Food- and nutrition-related knowledge deficit Limited access to a food that contains the substance Altered GI function, e.g., pain or discomfort

SUBOPTIMAL* BIOACTIVE SUBSTANCE INTAKE / Intake komponen bioaktif tidak optimal (NI-4.1)**
Dietary: Low intake of plant foods containing: Soluble fiber, e.g., psyllium ( total and LDL cholesterol) Soy protein ( total and LDL cholesterol) -glucan, e.g., whole oat products ( total and LDL cholesterol) Plant sterol and stanol esters, e.g., fortified margarines ( total and LDL cholesterol) Other substances (for which scientific evidence exists and a recommended intake level has been established)

Client History Conditions associated with a diagnosis or treatment, e.g., cardiovascular disease, elevated cholesterol

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EXCESSIVE BIOACTIVE SUBSTANCE INTAKE / Kelebihan intake komponen bioaktif (NI-4.2)

Definisi Higher intake of bioactive substances compared to established reference standards or recommendations based on physiological needs. Working definition of bioactive substancesphysiologically active components of foods that may offer health benefits beyond traditional macro- or micro-nutrient requirements. There is not scientific consensus about a definition for bioactive substances/components. Etiologi Food- and nutrition-related knowledge deficit concerning recommended bioactive substance intake including food additives Contamination, misname, mislabel or lack of labeling, misuse, recent brand change, recent dose increase, recent formulation change of substance consumed

EXCESSIVE BIOACTIVE SUBSTANCE INTAKE / Kelebihan intake komponen bioaktif (NI-4.2)

Etiologi (lanjutan) Frequent intake of foods containing bioactive substances Altered GI function, e.g., pain or discomfort Lack of or limited access to appropriate foods, e.g., inadequate markets with labeled food. Biochemical Data, Lab values indicating excessive intake of the specifi c substance, such as rapid decrease in cholesterol from intake of stanol or sterol esters and a statin drug and related dietary changes or medications Increased hepatic enzyme refl ecting hepatocellular damage Anthropometric: Weight loss as a result of malabsorption or maldigestion

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EXCESSIVE BIOACTIVE SUBSTANCE INTAKE / Kelebihan intake komponen bioaktif (NI-4.2)

Clinical: Constipation, diarrhea, nausea, stomach pain, gas, cramps or bloating, vomiting, heartburn. Neurologic changes, e.g., anxiety, mental status changes Cardiovascular changes, e.g., heart rate, EKG changes, blood pressure Headache/migraine Hives, flushing Irritability or nervousness Client History Conditions associated with a diagnosis or treatment, e.g., cardiovascular disease, elevated cholesterol, hypertension, asthma Discomfort or pain associated with intake of foods rich in bioactive substances, e.g., soluble fi ber, -glucan, soy protein

EXCESSIVE BIOACTIVE SUBSTANCE INTAKE / Kelebihan intake komponen bioaktif (NI-4.2)

Dietary: High intake of plant foods containing: Soy protein ( total and LDL cholesterol) -glucan, e.g., whole oat products ( total and LDL cholesterol) Plant sterol and stanol esters, e.g., fortifi ed margarines ( total and LDL cholesterol) or other foods based on dietary Substance, concentrate, metabolite, constituent, extract, or combination Substances that interfere with digestion or absorption of foodstuffs Ready access to available foods/products with bioactive substance, e.g., as from dietary supplement vendors Attempts to use supplements or bioactive substances for weight loss, to treat constipation, or to prevent or cure chronic or acute disease Other substances (for which scientific evidence exists and a recommended intake level has been established) Intake of food additives for which patient/client is intolerant, e.g., yellow 5, 6, safrole, FD&C Red #4, carmine, MSG, sulfites

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EXCESSIVE ALCOHOL INTAKE / Kelebihan intake alkohol (NI-4.3)

Definisi Intake more than the suggested limits for alcohol.

Etiologi Harmful beliefs/attitudes about food, nutrition, and nutrition-related topics Food- and nutrition-related knowledge deficit Lack of value for behaviour change, competing values Alcohol addiction
Sign/symptoms Biochemical Data, Medical Elevated aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), carbohydrate-defi cient transferrin, mean corpuscular volume, blood alcohol levels

EXCESSIVE ALCOHOL INTAKE / Kelebihan intake alkohol (NI-4.3)

Sign/symptoms
Dietary: Intake of > 2 drinks*/day (men) Intake of > 1 drink*/day (women) Binge drinking Consumption of any alcohol when contraindicated *1 drink = 5 oz wine, 12 oz beer, 1.5 oz distilled alcohol. Client History Conditions associated with a diagnosis or treatment, e.g., severe hypertriglyceridemia, elevated blood pressure, depression, liver disease, pancreatitis New medical diagnosis or change in existing diagnosis or condition History of excessive alcohol intake Giving birth to an infant with fetal alcohol syndrome Drinking during pregnancy despite knowledge of risk

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Class: Nutrient (5)

Term Number NI 5.1 NI 5.2 NI 5.3 NI 5.4 Ni 5.5 Nutrition Diagnostic Term Increased nutrient needs (specify) Evident protein-energy malnutrition Inadequate protein energy intake Decreased nutrient need (specify) Imbalance of nutrients

INCREASED NUTRIENT NEEDS (SPECIFY) / Peningkatan kebutuhan zat gizi tertentu (NI-5.1)
Definisi Increased need for a specific nutrient compared to established reference standards or recommendations based on physiological needs. Etiologi Altered absorption or metabolism of nutrient, e.g., from medications Compromise of organs related to GI function, e.g., pancreas, liver Decreased functional length of intestine, e.g., short-bowel syndrome Decreased or compromised function of intestine, e.g., celiac disease, Crohns disease Increased demand for nutrient, e.g., accelerated growth, wound healing, chronic infection

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INCREASED NUTRIENT NEEDS (SPECIFY) / Peningkatan kebutuhan zat gizi tertentu (NI-5.1)
Biochemical Data Decreased total cholesterol < 160 mg/dL, albumin, prealbumin, Creactive protein, indicating increased stress and increased metabolic needs Electrolyte/mineral (e.g., potassium, magnesium, phosphorus) abnormalities Urinary or fecal losses of specifi c or related nutrient (e.g., fecal fat, d-xylose test) Vitamin and/or mineral defi ciency Anthropometric: Growth failure, based on growth standards and fetal growth failure Unintentional weight loss of 5% in 1 month or 10% in 6 months Loss of muscle mass, subcutaneous fat Underweight (BMI < 18.5) Low percent body fat and muscle mass

INCREASED NUTRIENT NEEDS (SPECIFY) / Peningkatan kebutuhan zat gizi tertentu (NI-5.1)
Physical Examination Findings Clinical evidence of vitamin/mineral deficiency (e.g., hair loss, bleeding gums, pale nail beds) Loss of skin integrity, delayed wound healing, or pressure ulcers Dietary: Inadequate intake of foods/supplement containing needed nutrient as compared to estimated requirements Intake of foods that do not contain sufficient quantities of available nutrient (e.g., over processed, overcooked, or stored improperly) Food- and nutrition-related knowledge deficit (e.g., lack of information, incorrect information or noncompliance with intake of needed nutrient)

Client History Conditions associated with a diagnosis or treatment, e.g., intestinal resection, Crohns disease, HIV/AIDS, burns, pre-term birth, malnutrition Medications affecting absorption or metabolism of needed nutrient Athletes or active individuals engaged in intense physical activity

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MALNUTRITION / Malnutrisi (NI-5.2)**

Definisi Inadequate intake of protein and/or energy over prolonged periods of time resulting in loss of fat stores and/or muscle wasting including starvation-related malnutrition, chronic disease-related malnutrition and acute disease or injury-related malnutrition. Etiologi Physiological causes increasing nutrient needs due to illness, acute or chronic or injury/trauma Lack of access to food, e.g., economic constraints, cultural or religious practices, restricting food given to elderly and/or children Food- and nutrition-related knowledge deficit, e.g., avoidance of high-quality protein foods Psychological causes, e.g., depression or eating disorders Cultural practices or religious that affect the ability to access food

MALNUTRITION / Malnutrisi (NI-5.2)**

Biochemical Data, Medical Normal serum albumin level (uncomplicated malnutrition) Albumin* < 3.4 mg/dL (disease/trauma related malnutrition) * In the past, hepatic transport protein measures (e.g. albumin and pre-albumin) were used as indicators of malnutrition. The sensitivity of these as nutrition indicators has been questioned. An ADA evidence-analysis project is evaluating the body of science. Anthropometric: BMI < 18.5 indicates underweight; BMI for older adults (older than 65 years) < 23; BMI < 5th percentile in children Failure to thrive, e.g., failure to attain desirable growth rates Inadequate maternal weight gain Weight loss, adults, of > 20% in 1 year, > 10% in 6 months, > 7.5% in 3 months, > 5% in 1 month, > 1-2% in 1 week Underweight with muscle wasting Growth, paediatrics, not gaining weight as expected and/or a shift downward in their growth percentiles, crossing two or more percentiles on their growth charts. Malnutrition can occur at any weight/BMI

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MALNUTRITION / Malnutrisi (NI-5.2)**

Clinical: Loss of subcutaneous fat, e.g., orbital, triceps, fat overlying the ribs and/or muscle wasting, e.g., wasting of the temples (tempralis muscle), clavicles (pectoralis & deltoids), shoulders (deltoids), interosseous muscles, scapula (latissimus dorsi, trape-zious, deltoids), thigh (quadriceps) and calf (gastrocnemius). Localized or generalized fluid accumulation Change in functional indicators, e.g., grip strength or other measures of physical activity and/or strength Dietary: Insuffi cient energy intake from diet compared to estimated or measured RMR Insuffi cient intake of high-quality protein when compared to requirements Food avoidance and/or lack of interest in food Unable or unwilling to eat sufficient energy/protein to maintain a healthy weight Estimated intake of high-quality protein less than estimated requirements Anorexia nervosa, benign esophageal stricture, and anything that results in limited access to food (associated with starvation-related malnutrition)

MALNUTRITION / Malnutrisi (NI-5.2)**

Client History Excessive consumption of alcohol or other drugs that reduce hunger Organ failure, malignancies, rheumatoid diseases, gastrointestinal diseases, sarcopenic obesity, malabsorptive syndromes, and other etiologies including but not limited to diabetes, congestive heart failure and chronic obstructive pulmonary disease (associated with chronic disease-related malnutrition) Major infections such as; sepsis, pneumonia, peritonitis, and wound infections, major burns, trauma, closed head injury, acute lung injury, adult respiratory distress syndrome, and selected major surgeries (associated with acute disease or injury-related malnutrition) Existing medical diagnosis of malnutrition including starvation-related malnutrition, chronic disease-related malnutrition and acute disease or injuryrelated malnutrition.

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INADEQUATE* PROTEINENERGY INTAKE / Intake energi-protein tidak adekuat (NI-5.3)**

Definisi Inadequate intake of protein and/or energy compared to established reference standards or recommendations based on physiological needs of short or recent duration. Note: Whenever possible, nutrient intake data should be considered in combination with clinical, biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors as well as diet to provide a valid assessment of nutritional status based on a totality of the evidence. Etiologi Short-term physiological causes, e.g., increased nutrient needs due to catabolic illness, malabsorption Recent lack of access to food, e.g., economic constraints, cultural or religious practices, restricting food given or food selected Cultural or religious practices that affect ability to access food Food- and nutrition-related knowledge defi cit, e.g., avoidance of all fats for new dieting pattern Recent onset of psychological causes, e.g., depression or eating disorders Decreased ability to consume sufficient protein and/or energy

INADEQUATE* PROTEINENERGY INTAKE / Intake energi-protein tidak adekuat (NI-5.3)**

Biochemical Data Normal albumin (in the setting of normal liver function despite decrease protein-energy intake) Anthropometric: Inadequate maternal weight gain (mild but not severe) Weight loss of 5%->7% during past in 3 months, >5% in one month, 1-2% in 1 week in adults, any weight loss or failure to gain weight in children Growth failure in children Clinical: Slow wound healing in pressure ulcer or surgical patient/client

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INADEQUATE* PROTEINENERGY INTAKE / Intake energi-protein tidak adekuat (NI-5.3)**

Dietary: Insufficient energy intake from diet compared to estimated or measured RMR or recommended levels Restriction or omission of food groups such as dairy or meat group foods (protein); bread or milk group foods (energy) Recent food avoidance and/or lack of interest in food Lack of ability to prepare meals Client History Conditions associated with a diagnosis or treatment of mild protein-energy malnutrition, recent illness, e.g., pulmonary or cardiac failure, flu, infection, surgery Nutrient malabsorption (e.g., bariatric surgery, diarrhea, steatorrhea) Excessive consumption of alcohol or other drugs that reduce hunger Patient/client reports of hunger in the face of inadequate access to food supply Patient/client reports lack of ability to prepare meals Patient/client reports lack of funds for purchase of appropriate foods

DECREASED NUTRIENT NEEDS (SPECIFY) / Penurunan Kebutuhan Zat Gizi tertentu (NI-5.4)
Definisi Decreased need for a specific nutrient compared to established reference standards or recommendations based on physiological needs. Etiologi Renal dysfunction Liver dysfunction Altered cholesterol metabolism/regulation Heart failure Food intolerances, e.g., irritable bowel syndrome

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DECREASED NUTRIENT NEEDS (SPECIFY) / Penurunan Kebutuhan Zat Gizi tertentu (NI-5.4)

Biochemical Data, Medical Total cholesterol > 200 mg/dL (5.2 mmol/L), LDL cholesterol > 100 mg/dL (2.59 mmol/L), HDL cholesterol < 40 mg/dL (1.036 mmol/L), triglycerides > 150 mg/dL (1.695 mmol/L) Phosphorus > 5.5 mg/dL (1.78 mmol/L) Glomerular fi ltration rate (GFR) < 90 mL/min/1.73 m2 Elevated BUN, creatinine, potassium Liver function tests indicating severe liver disease Anthropometric: Interdialytic weight gain greater than expected

DECREASED NUTRIENT NEEDS (SPECIFY) / Penurunan Kebutuhan Zat Gizi tertentu (NI-5.4)
Clinical: Edema/fluid retention Dietary: Intake higher than recommended for fat, phosphorus, sodium, protein, fi ber Client History Conditions associated with a diagnosis or treatment that require a specific type and/or amount of nutrient, e.g., cardiovascular disease (fat), early renal disease (protein, phos), ESRD (phos, sodium, potassium, fl uid), advanced liver disease (protein), heart failure (sodium, fl uid), irritable bowel disease/Crohns fl are up (fi ber) Diagnosis of hypertension, confusion related to liver disease

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IMBALANCE OF NUTRIENTS /Ketidakseimbangan zat gizi (NI-5.5)

Definisi An undesirable combination of nutrients, such that the amount of one nutrient interferes with or alters absorption and/or utilization of another nutrient Etiologi Factors gathered during the nutrition assessment process that contribute to the existence or the maintenance of pathophysiological, psychosocial, situational, developmental, cultural, and/or environmental problems: Consumption of high-dose nutrient supplements Food- and nutrition-related knowledge defi cit Harmful beliefs/attitudes about food, nutrition, and nutrition-related information Food faddism Insuffi cient electrolyte replacement when initiating feeding (PN/EN, including oral)

IMBALANCE OF NUTRIENTS /Ketidakseimbangan zat gizi (NI-5.5)

Biochemical Data Severe hypophosphatemia ( carbohydrate) Severe hypokalemia ( protein) Severe hypomagnesemia (carbohydrate) Refeeding syndrome Dietary: High intake of iron supplements ( zinc absorption) High intake of zinc supplements ( copper status) High intake of manganese ( iron status) Client History Diarrhea or constipation (iron supplements) Epigastric pain, nausea, vomiting, diarrhea (zinc supplements) Contributes to the development of anemia (manganese supplements)

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Class: Nutrient (5) Sub class: fat and cholesterol (5.6)

Term Number NI 5.6.1 Nutrition Diagnostic Term Inadequate fat intake

NI 5.6.2 NI 5.6.3

Excessive fat intake Inappropriate intake of ffod fats (specify)

INADEQUATE* FAT INTAKE / Intake lemak tidak adekuat (NI-5.6.1)

Definisi Lower fat intake compared to established reference standards or recommendations based on physiological needs. Note: May not be an appropriate nutrition diagnosis when the goal is weight loss or during end-of-life care. Whenever possible, nutrient intake data should be considered in combination with clinical, biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors as well as diet to provide a valid assessment of nutritional status based on a totality of the evidence. Etiologi Inappropriate food choices, e.g., economic constraints, cultural or religious practices, restricting food given to elderly and/or children, specifi c food choices Food- and nutrition-related knowledge defi cit, e.g., prolonged adherence to a very low-fat diet Psychological causes, e.g., depression or disordered eating Alteration in gastrointestinal tract structure and/or function

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INADEQUATE* FAT INTAKE / Intake lemak tidak adekuat (NI-5.6.1)

Biochemical Data Triene: tetraene ratio > 0.2 Anthropometric: Impaired growth Weight loss if insuffi cient calories consumed Physical Examination Findings Scaly skin and dermatitis consistent with essential fatty acid defi ciency Dietary: Intake of essential fatty acids less than 10% of energy (primarily associated with PN) Client History Conditions associated with a diagnosis or treatment, e.g., prolonged catabolic illness (e.g., AIDS, tuberculosis, anorexia nervosa, sepsis or severe infection from recent surgery) Severe fat malabsorption with bowel resection, pancreatic insuffi ciency, or hepatic disease accompanied by steatorrhea

EXCESSIVE FAT INTAKE / Kelebihan intake lemak (NI-5.6.2)

Definisi Higher fat intake compared to established reference standards or recommendations based on physiological needs. Etiologi Food- and nutrition-related knowledge defi cit Harmful beliefs/attitudes about food, nutrition, and nutrition-related topics Lack of access to healthful food choices, e.g., healthful food choices not provided as an option by caregiver or parent, homeless Changes in taste and appetite or preference Lack of value for behavior change, competing values

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EXCESSIVE FAT INTAKE / Kelebihan intake lemak (NI-5.6.2)

Biochemical Data Cholesterol > 200 mg/dL (5.2 mmol/L), LDL cholesterol > 100 mg/dL (2.59 mmol/L), HDL cholesterol < 40 mg/dL (1.036 mmol/L), triglycerides > 150 mg/dL (1.695 mmol/L) Elevated serum amylase and/or lipase Elevated LFTs, T. Bili Fecal fat > 7g/24 hours Clinical: Evidence of xanthomas

EXCESSIVE FAT INTAKE / Kelebihan intake lemak (NI-5.6.2)

Dietary: Frequent or large portions of high-fat foods Frequent food preparation with added fat Frequent consumption of high risk lipids (i.e., saturated fat, trans fat, cholesterol) Report of foods containing fat more than diet prescription Client History Conditions associated with a diagnosis or treatment, e.g., hyperlipidemia, cystic fi brosis, angina, artherosclerosis, pancreatic, liver, and biliary diseases, post-transplantation Medication, e.g., pancreatic enzymes, cholesterol- or other lipidlowering medications Diarrhea, cramping, steatorrhea, epigastric pain Family history of hyperlipidemia, atherosclerosis, or pancreatitis

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INAPPROPRIATE INTAKE OF FATS (SPECIFY) / Ketidaksesuaian intake lemak tertentu (NI-5.6.3)**

Definisi Intake of wrong type or quality of fats compared to established reference standards or recommendations based on physiological needs. Etiologi Food- and nutrition-related knowledge deficit concerning type of fat (e.g., fats added to food, formula/breastmilk) Harmful beliefs/attitudes about food, nutrition, and nutrition-related topics Lack of access to healthful food choices, e.g., healthful food choices not provided as an option by caregiver or parent, homeless Changes in taste and appetite or preference Lack of value for behavior change, competing values Client History Conditions associated with a diagnosis or treatment of diabetes, cardiac diseases, obesity, liver or biliary disorders Diarrhea, cramping, steatorrhea, epigastric pain Family history of diabetes-related heart disease, hyperlipidemia, atherosclerosis, or pancreatitis

INAPPROPRIATE INTAKE OF FATS (SPECIFY) / Ketidaksesuaian intake lemak tertentu (NI-5.6.3)**

Biochemical Data, Cholesterol > 200 mg/dL (5.2 mmol/L), LDL cholesterol > 100 mg/dL (2.59 mmol/L), HDL cholesterol < 40 mg/dL (1.036 mmol/L), triglycerides > 150 mg/dL (1.695 mmol/L) Elevated serum amylase and/or lipase Elevated LFTs, T. Bili, C-reactive protein Anthropometric Measurements Physical Exam Findings Evidence of dermatitis Food/Nutrition History Reports or observations of: Frequent food preparation with added fat that is not of desired type for condition Frequent consumption of fats that are undesirable for condition (i.e., saturated fat, trans fat, cholesterol, -6 fatty acids) Estimated intake of monounsaturated, polyunsaturated, -3 fatty acids, or DHA/ARA less than recommended or in suboptimal ratio. Client History Conditions associated with a diagnosis or treatment of diabetes, cardiac diseases, obesity, liver or biliary disorders Diarrhea, cramping, steatorrhea, epigastric pain Family history of diabetes-related heart disease, hyperlipidemia, atherosclerosis, or pancreatitis

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Class: Nutrient (5) Sub class: protein (5.7)

Term Number NI 5.7.1 NI 5.7.2 NI 5.7.3 Nutrition Diagnostic Term Inadequate protein intake Excessive protein intake Inappropriate intake of amino acids (specify)

INADEQUATE PROTEIN INTAKE / Intake protein tidak adekuat (NI-5.7.1)

Definisi Lower intake of protein compared to established reference standards or recommendations based on physiological needs. Note:Whenever possible, nutrient intake data should be considered in combination with clinical, biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors as well as diet to provide a valid assessment of nutritional status based on a totality of the evidence. Etiologi Physiological causes, e.g., increased nutrient needs due to prolonged catabolic illness, malabsorption, age, or condition Lack of access to food, e.g., economic constraints, cultural or religious practices, restricting food given to elderly and/or children Food- and nutrition-related knowledge deficit concerning amount of protein Psychological causes, e.g., depression or disordered eating Decreased ability to consume sufficient protein

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INADEQUATE PROTEIN INTAKE / Intake protein tidak adekuat (NI-5.7.1) Clinic: Edema, failure to thrive (infants/children), poor musculature, dull skin, thin and fragile hair Food/Nutrition History Reports or observation of: Insuffi cient intake of protein to meet requirements Cultural or religious practices that limit protein intake Economic constraints that limit food availability Prolonged adherence to a verylow-protein weight-loss diet Client History Conditions associated with a diagnosis or treatment, e.g., severe protein malabsorption such as bowel resection

EXCESSIVE PROTEIN INTAKE / Kelebihan intake protein (NI-5.7.2)

Definisi Intake more than the recommended level of protein compared to established reference standards or recommendations based on physiological needs. Etiologi Liver dysfunction Renal dysfunction Harmful beliefs/attitudes about food, nutrition, and nutrition-related topics Lack of access to specialized protein products Metabolic abnormality Food faddism

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EXCESSIVE PROTEIN INTAKE / Kelebihan intake protein (NI-5.7.2)

Biochemical Data Altered laboratory values, e.g., BUN, glomerular fi ltration rate (altered renal status) Anthropometric: Growth stunting or failure based growth reference (metabolic disorders) Dietary: Higher than recommended total protein intake, e.g., early renal disease, advanced liver disease with confusion Inappropriate supplementation Client History Conditions associated with a diagnosis or treatment, e.g., early renal disease or advanced liver disease with confusion

INAPPROPRIATE INTAKE OF PROTEIN OR AMINO ACIDS (SPECIFY) / Ketidaksesuaian intake protein atau asam amino tertentu (NI-5.7.3)**
Definisi Intake of a amount of a specific type of protein or amino acids compared to established reference standards or recommendations based on physiological needs. Etiologi Liver dysfunction, Renal dysfunction, Metabolic abnormality Harmful beliefs/attitudes about food, nutrition, and nutrition-related topics Misused specialized protein products Food faddism Inborn errors of metabolism

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INAPPROPRIATE INTAKE OF PROTEIN OR AMINO ACIDS (SPECIFY) / Ketidaksesuaian intake protein atau asam amino tertentu (NI-5.7.3)**
Etiologi (lanjutan) Celiac disease, dermatitis herpetiformis Cultural or religious practices that affect the ability to regulate types of protein or amino acids consume Food- and nutrition-related knowledge deficit concerning an appropriate amount of a specific types of proteins or amino acids Food and nutrition compliance limitations, e.g., lack of willingness or failure to modify protein or amino acid intake in response to recommendations from a dietitian, physician, or caregiver Clinical: Physical or neurological changes (inborn errors of metabolism) Diarrhea in response to certain types of carbohydrates Abdominal pain, distention, constipation, reflux, GERD

INAPPROPRIATE INTAKE OF PROTEIN OR AMINO ACIDS (SPECIFY) / Ketidaksesuaian intake protein atau asam amino tertentu (NI-5.7.3)**
Biochemical Data, Medical Altered laboratory values, e.g., BUN, glomerular filtration rate (altered renal status) Elevated specifi c amino acids (inborn errors of metabolism) Elevated homocysteine or ammonia Positive autoantibody levels (Anti-Ttg antibodies, EmA IgA Tissue Transglutaminase (tTG) and IgA Endomysial Antibodies (EMA)) Positive small bowel biopsy for celiac disease Anthropometric: Weight loss, inability to gain weight, delayed growth

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INAPPROPRIATE INTAKE OF PROTEIN OR AMINO ACIDS (SPECIFY) / Ketidaksesuaian intake protein atau asam amino tertentu (NI-5.7.3)**
Food/Nutrition History Reports or observation of: Estimated protein or amino acid intake higher than recommended, e.g., early renal disease, advanced liver disease, inborn error of metabolism, celiac disease Estimated intake of certain types of proteins or amino acids higher than recommended for prescribed parenteral and enteral nutrition therapy Inappropriate amino acid or protein supplementation, as for athletes Higher than recommended amino acid intake, e.g., excess phenylalanine intake Client History Conditions associated with a diagnosis or treatment of illness that requires EN/PN therapy, celiac disease, dermatitis herpetiformis, allergies, inborn errors of metabolism History of inborn error of metabolism Uremia, azotemia (renal patients) Limited knowledge of protein or amino acid Composition of foods or of protein or amino acid metabolism Chronic use of medications contain proteins not recommended

Class: Nutrient (5) Sub class: carbohydrate and fiber (5.8)

Term Number NI 5.8.1 NI 5.8.2 NI 5.8.3 NI 5.8.4 NI 5.8.5 NI 5.8.6 Nutrition Diagnostic Term Inadequate carbohydrate intake Excessive carbohydrate intake Inappropriate intake of types of carbohydrate (specify) Inconsistent carbohydrate intake Inadequate fiber intake Excessive fiber intake

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INADEQUATE* CARBOHYDRATE INTAKE / Intake karbohidrat tidak adekuat (NI-5.8.1)

Definisi Lower intake of carbohydrate compared to established reference standards or recommendations based on physiological needs. Note: Whenever possible, nutrient intake data should be considered in combination with clinical, biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors as well as diet to provide a valid assessment of nutritional status based on a totality of the evidence. Etiologi Physiological causes, e.g., increased energy needs due to increased activity level or metabolic change, malabsorption Lack of access to food, e.g., economic constraints, cultural or religious practices, restricting food given to elderly and/or children Food- and nutrition-related knowledge defi cit Psychological causes, e.g., depression or disordered eating

INADEQUATE* CARBOHYDRATE INTAKE / Intake karbohidrat tidak adekuat (NI-5.8.1)

Physical Examination Findings Ketone smell on breath Food/Nutrition History Reports or observation of: Carbohydrate intake less than recommended amounts Inability to independently consume foods/fluids, e.g., diminished mobility in hand, wrist, or digits Client History Conditions associated with a diagnosis or treatment, e.g., pancreatic insufficiency, hepatic disease, celiac disease, seizure disorder, or carbohydrate malabsorption

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EXCESSIVE CARBOHYDRATE INTAKE / Kelebihan intake karbohidrat (NI-5.8.2)

Definisi Intake more than the recommended level and type of carbohydrate compared to established reference standards or recommendations based on physiological needs. Etiologi Physiological causes requiring modifi ed carbohydrate intake, e.g., diabetes mellitus, lactase defi ciency, sucrase-isomaltase defi ciency, aldolase-B deficiency Cultural or religious practices that interfere with the ability to reduce carbohydrate intake Food- and nutrition-related knowledge deficit, e.g., inability to access sufficient information concerning appropriate carbohydrate intake Food and nutrition compliance limitations, e.g., lack of willingness or failure to modify carbohydrate intake in response to recommendations from a dietitian or physician Psychological causes, e.g., depression or disordered eating

EXCESSIVE CARBOHYDRATE INTAKE / Kelebihan intake karbohidrat (NI-5.8.2)

Biochemical Data, Medical Hyperglycemia (fasting blood sugar > 126 mg/dL) Hemoglobin A1C > 6% Abnormal oral glucose tolerance test (2-hour post load glucose > 200 mg/dL) Physical Examination Findings Dental caries Diarrhea in response to carbohydrate feeding Food/Nutrition History Reports or observation of: Cultural or religious practices that do not support modifi cation of dietary carbohydrate intake Economic constraints that limit availability of appropriate foods Carbohydrate intake that is consistently more than recommended amounts

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EXCESSIVE CARBOHYDRATE INTAKE / Kelebihan intake karbohidrat (NI-5.8.2)

Client History Conditions associated with a diagnosis or treatment of, e.g., diabetes mellitus, inborn errors of carbohydrate metabolism, lactase defi ciency, severe infection, sepsis, or obesity Chronic use of medications that cause hyperglycemia, e.g., steroids Pancreatic insuffi ciency resulting in reduced insulin production

INAPPROPRIATE INTAKE OF TYPES OF CARBOHYDRATES (SPECIFY) / Ketidaksesuaian intake jenis karbohidrat tertentu (NI-5.8.3)

Definisi Intake of an amount of a specific the type or amount of carbohydrate that is more or less than the established reference standards or recommendations based on physiological needs. Note: Types of carbohydrate can refer generally to sugars, starch and fiber or specific carbohydrates (e.g., sucrose, fructose, lactose). Intolerance to the protein component of grains (e.g., gluten) should be documented using the Inappropriate intake of proteins or amino acids (NI-5.7.3) reference sheet.

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INAPPROPRIATE INTAKE OF TYPES OF CARBOHYDRATES (SPECIFY) / Ketidaksesuaian intake jenis karbohidrat tertentu (NI5.8.3)
Etiologi Physiological causes requiring careful use of modified carbohydrate, e.g., diabetes mellitus, metabolic syndrome, hypoglycemia, celiac disease, allergies, intolerance, inborn errors of carbohydrate metabolism obesity. Note. Although research does not support restriction of individual types of carbohydrate for glycemic control, dietetics practitioners may determine that restriction is warranted in unique patient/client situations for glycemic control and/or for other reasons, such as, promotion of healthful eating. Cultural or religious practices that affect the ability to regulate types of carbohydrate consumed Food- and nutrition-related knowledge defi cit, e.g., inability to access suffi cient information concerning more appropriate carbohydrate types and/or amounts Food and nutrition compliance limitations, e.g., lack of willingness or failure to modify carbohydrate intake in response to recommendations from a dietitian, physician, or caregiver Psychological causes, e.g., depression or disordered eating

INAPPROPRIATE INTAKE OF TYPES OF CARBOHYDRATES (SPECIFY) / Ketidaksesuaian intake jenis karbohidrat tertentu (NI5.8.3)
Biochemical Data Hypoglycemia or hyperglycemia Dietary: Diarrhea in response to high intake of refi ned carbohydrates Economic constraints that limit availability of appropriate foods Carbohydrate intake that is a different from recommended types or exceeds amount recommended for that specific type of carbohydrate Allergic reactions or intolerance to certain carbohydrate foods or food groups Limited knowledge of carbohydrate composition of foods or of carbohydrate metabolism

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INAPPROPRIATE INTAKE OF TYPES OF CARBOHYDRATES (SPECIFY)

/

Ketidaksesuaian intake jenis karbohidrat tertentu (NI-5.8.3)

Antropometri: Weight loss, inability to gain weight, delayed growth Clinical: Diarrhea in response to certain types of high intake of refined carbohydrates Abdominal pain, distention, constipation, reflux, GERD Client History Conditions associated with a diagnosis or treatment, e.g., diabetes mellitus, obesity, metabolic syndrome, hypoglycemia, intolerance, inborn errors of metabolism Chronic use of medications that cause altered glucose levels, e.g., steroids, antidepressants, antipsychotics or contains a type of carbohydrate not recommended

INCONSISTENT CARBOHYDRATE INTAKE / Intake Karbohidrat tidak konsisten (NI-5.8.4)

Definisi Inconsistent timing of carbohydrate intake throughout the day, day to day, or a pattern of carbohydrate intake that is not consistent with recommended pattern based on physiological or medication needs. Etiologi Physiological causes requiring careful timing and consistency in the amount of carbohydrate, e.g., diabetes mellitus, hypoglycemia, PN/EN delivery Cultural or religious practices or lifestyle factors that interfere with the ability to regulate timing of carbohydrate consumption Food- and nutrition-related knowledge defi cit, e.g., inability to access suffi cient information concerning more appropriate timing of carbohydrate intake Food and nutrition compliance limitations, e.g., lack of willingness or failure to modify carbohydrate timing in response to recommendations from a dietitian, physician, or caregiver Psychological causes, e.g., depression or disordered eating

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INCONSISTENT CARBOHYDRATE INTAKE / Intake Karbohidrat tidak konsisten (NI-5.8.4)

Biochemical Data Hypoglycemia or hyperglycemia documented on regular basis associated with inconsistent carbohydrate intake Wide variations in blood glucose levels Dietary: Economic constraints that limit availability of appropriate foods Carbohydrate intake that is different from recommended types or ingested on an irregular basis Client History Conditions associated with a diagnosis or treatment, e.g., diabetes mellitus, obesity, metabolic syndrome, hypoglycemia Use of insulin or insulin secretagogues Chronic use of medications that cause altered glucose levels, e.g., steroids, antidepressants, antipsychotics

INADEQUATE* FIBER INTAKE / Intake serat tidak adekuat (NI-5.8.5)

Definisi Lower intake of fiber compared to established reference standards or recommendations based on physiological needs. Note: Whenever possible, nutrient intake data should be considered in combination with clinical, biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors as well as diet to provide a valid assessment of nutritional status based on a totality of the evidence. Etiologi Lack of or limited access to fiber-containing foods/fluids Food- and nutrition-related knowledge defi cit Psychological causes, e.g., depression or disordered eating Prolonged adherence to a low-fi ber or low-residue diet Difficulty chewing or swallowing high-fiber foods Economic constraints that limit availability of appropriate foods Inability or unwillingness to purchase or consume fiber-containing foods Inappropriate food preparation practices, e.g., reliance on overprocessed, overcooked foods

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INADEQUATE* FIBER INTAKE / Intake serat tidak adekuat (NI-5.8.5)

Dietary: Insuffi cient intake of fi ber when compared to recommended amounts (38 g/day for men and 25 g/day for women) Client History Conditions associated with a diagnosis or treatment, e.g., ulcer disease, infl ammatory bowel disease, or short-bowel syndrome treated with a low-fi ber diet Low stool volume, constipation Inadequate fecal bulk

EXCESSIVE FIBER INTAKE / Kelebihan intake serat (NI-5.8.6)

Definisi Higher intake of fi ber-containing foods or substances compared to recommendations based on patient/client condition. Etiologi Food- and nutrition-related knowledge defi cit about desirable quantities of fi ber for individual condition Harmful beliefs or attitudes about food- or nutrition-related topics, e.g., obsession with bowel frequency and habits Lack of knowledge about appropriate fi ber intake for condition Food preparation or eating patterns that involve only highfiber foods to the exclusion of other nutrient-dense foods

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EXCESSIVE FIBER INTAKE / Kelebihan intake serat (NI-5.8.6)

Dietary: Fiber intake higher than tolerated or generally recommended for current medical condition Client History Conditions associated with a diagnosis or treatment, e.g., ulcer disease, irritable bowel syndrome, infl ammatory bowel disease, short-bowel syndrome, diverticulitis, obstructive constipation, prolapsing hemorrhoids, gastrointestinal stricture, eating disorders, or mental illness with obsessive-compulsive tendencies Nausea, vomiting, excessive fl atulence, diarrhea, abdominal cramping, high stool volume or frequency that causes discomfort to the individual; obstruction; phytobezoar

Class: Nutrient (5) Sub class: vitamin (5.9)

Term Number NI 5.9.1 NI 5.9.2 Nutrition Diagnostic Term Inadequate vitamin intake (specify) Excessive vitamin intake (specify)

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INADEQUATE VITAMIN INTAKE (SPECIFY) / Intake vitamin tidak adekuat (NI-5.9.1)

Definisi Lower intake of one or more vitamins compared to established reference standards or recommendations based on physiological needs. Note: Whenever possible, nutrient intake data should be considered in combination with clinical, biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors as well as diet to provide a valid assessment of nutritional status based on a totality of the evidence. Etiologi Physiological causes, e.g., increased nutrient needs due to prolonged catabolic illness, disease state, malabsorption, or medications Lack of access to food, e.g., economic constraints, cultural or religious practices, restricting food given to elderly and/or children Food- and nutrition-related knowledge defi cit concerning food sources of vitamins Psychological causes, e.g., depression or eating disorders Decreased ability to consume sufficient amount of a vitamin (s)

INADEQUATE VITAMIN INTAKE (SPECIFY) / Intake vitamin tidak adekuat (NI-5.9.1)

Biochemical Data Vitamin A: serum retinol < 10 g/dL (0.35 mol/L) Vitamin C: plasma concentrations < 0.2 mg/dL (11.4 mol/L) Vitamin D: ionized calcium < 3.9 mg/dL (0.98 mmol/L) with elevated parathyroid hormone, normal serum calcium, and serum phosphorus < 2.6 mg/dL (0.84 mmol/L) Vitamin E: plasma alpha-tocopherol < 18 mol/g (41.8 mol/L) Vitamin K: elevated prothrombin time; altered INR (without anticoagulation therapy) Thiamin: erythrocyte transketolase activity > 1.20 g/mL/h Ribofl avin: erythrocyte glutathione reductase > 1.2 IU/g hemoglobin Niacin: Nmethyl-nicotinamide excretion < 5.8 mol/day Vitamin B-6: plasma pryrdoxal 5phosphate <5 ng/mL (20 nmol/L) Vitamin B-12: serum concentration < 24.4 ng/dL (180 pmol/L); elevated homocysteine Folic acidserum concentration < 0.3 g/dL (7 nmol/L); red cell folate < 315 nmol/L

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INADEQUATE VITAMIN INTAKE (SPECIFY) / Intake vitamin tidak adekuat (NI-5.9.1)

Clinical: Vitamin A: night blindness, Bitots spots, xerophthalmia, follicular hyperkeratosis Vitamin C: follicular hyperkeratosis, petichiae, ecchymosis, coiled hairs, infl amed and bleeding gums, perifolicular hemorrhages, joint effusions, arthralgia, and impaired wound healing Vitamin D: widening at ends of long bones Ribofl avin: sore throat, hyperemia, edema of pharyngeal and oral mucous membranes, cheilosis, angular stomatitis, glossitis, magenta tongue, seborrheic dermatitis, and normochromic, normocytic anemia with pure erythrocyte cytoplasia of the bone marrow Niacin: symmetrical, pigmented rash on areas exposed to sunlight; bright red tongue Vitamin B-6: seborrheic dermatitis, stomatitis, cheilosis, glossitis, confusion, depression Vitamin B-12: tingling and numbness in extremities, diminished vibratory and position sense, motor disturbances including gait disturbances

INADEQUATE VITAMIN INTAKE (SPECIFY) / Intake vitamin tidak adekuat (NI-5.9.1)

Dietary: Dietary history refl ects inadequate intake of foods containing specifi c vitamins as compared to requirements or recommended level Dietary history refl ects excessive consumption of foods that do not contain available vitamins, e.g., over processed, overcooked, or improperly stored foods Prolonged use of substances known to increase vitamin requirements or reduce vitamin absorption Lack of interest in foods Vitamin/mineral defi ciency Client History Conditions associated with a diagnosis or treatment, e.g., malabsorption as a result of celiac disease, short-bowel syndrome, or infl ammatory bowel Certain environmental conditions, e.g., infants exclusively fed breast milk with limited exposure to sunlight (Vitamin D) Rachitic rosary in children, rickets, osteomalacia Pellegra

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EXCESSIVE VITAMIN INTAKE (SPECIFY) / Kelebihan intake vitamin tertentu (NI-5.9.2)

Definisi Higher intake of vitamin-containing foods or substances compared to established reference standards or recommendations based on physiological needs. Etiologi Physiological causes, e.g., decreased nutrient needs due to prolonged immobility or chronic renal disease Access to foods and supplements in excess of needs, e.g., cultural or religious practices, inappropriate food and supplements given to pregnant women, elderly, or children Food- and nutrition-related knowledge defi cit concerning food and supplemental sources of vitamins Psychological causes, e.g., depression or eating disorders Accidental overdose from oral and supplemental forms, enteral or parenteral sources

EXCESSIVE VITAMIN INTAKE (SPECIFY) / Kelebihan intake vitamin tertentu (NI-5.9.2)

Biochemical Data Vitamin D: ionized calcium > 5.4 mg/dL (1.35 mmol/L) with elevated parathyroid hormone, normal serum calcium, and serum phosphorus > 2.6 mg/dL (0.84 mmol/L) Vitamin K: slowed prothrombin time or altered INR Niacin: Nmethyl-nicotinamide excretion > 7.3 mol/day Vitamin B-6: plasma pryrdoxal 5phosphate > 15.7 ng/mL (94 noml/L) Vitamin A: serum retinol concentration > 60 g/dL (2.09 mol/L) Anthropometric: Vitamin D: growth retardation

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EXCESSIVE VITAMIN INTAKE (SPECIFY) / Kelebihan intake vitamin tertentu (NI-5.9.2)

Clinical: Vitamin A: changes in the skin and mucous membranes; dry lips (cheilitis); earlydryness of the nasal mucosa and eyes; laterdryness, erythema, scaling and peeling of the skin, hair loss, and nail fragility. Headache, nausea, and vomiting. Infants may have bulging fontanelle; children may develop bone alterations. Vitamin D: elevated serum calcium (hypercalcemia) and phosphorus (hyperphosphatemia) levels; calcifi cation of soft tissues (calcinosis), including the kidney, lungs, heart, and even the tympanic membrane of the ear, which can result in deafness. Headache and nausea. Infants given excessive amounts of vitamin D may have gastrointestinal upset, bone fragility. Vitamin K: hemolytic anemia in adults or severe jaundice in infants have been noted on rare occasions Niacin: histamine release, which causes fl ushing, aggravation of asthma, or liver disease

EXCESSIVE VITAMIN INTAKE (SPECIFY) / Kelebihan intake vitamin tertentu (NI-5.9.2)

Dietary: History or measured intake refl ects excessive intake of foods and supplements

containing vitamins as compared to estimated requirements, including fortifi ed cereals, meal replacements, vitamin-mineral supplements, other dietary supplements (e.g., fi sh liver oils or capsules), tube feeding, and/or parenteral solutions Intake > Tolerable Upper Limit (UL) for vitamin A (as retinol ester, not as carotene) is 600 g/d for infants and toddlers; 900 g/d for children 4-8 y, 1700 g/d for children 9-13 y, 2800 for children 14-18 y, and 3000 g/d for adults Intake more than UL for vitamin D is 25 g/d for infants and 50 g/d for children and adults Niacin: clinical, high-dose niacinamide (NA), 1-2 g, three times per day, can have side effects Client History Conditions associated with a diagnosis or treatment, e.g., chronic liver or kidney diseases, heart failure, cancer

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Class: Nutrient (5) Sub class: mineral (5.10)

Term Number NI 5.10.1 NI 5.10.2 Nutrition Diagnostic Term Inadequate mineral intake (specify) Excessive mineral intake (specify)

INADEQUATE* MINERAL INTAKE (SPECIFY) / Intake mineral tertentu tidak adekuat (NI-5.10.1)
Definisi Lower intake of one or more minerals compared to established reference standards or recommendations based on physiological needs. Note:Whenever possible, nutrient intake data should be considered in combination with clinical, biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors as well as diet to provide a valid assessment of nutritional status based on a totality of the evidence. Etiologi Physiological causes, e.g., increased nutrient needs due to prolonged catabolic illness, malabsorption, hyperexcretion, nutrient/drug and nutrient/nutrient interaction, growth and maturation Lack of access to food, e.g., economic constraints, cultural or religious practices, restricting food given to elderly and/or children

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INADEQUATE* MINERAL INTAKE (SPECIFY) / Intake mineral tertentu tidak adekuat (NI-5.10.1)
Etiologi (lanjutan) Food- and nutrition-related knowledge defi cit concerning food sources of minerals; misdiagnosis of lactose intolerance/lactase defi ciency; perception of confl icting nutrition messages from health professionals; inappropriate reliance on supplements Psychological causes, e.g., depression or eating disorders Environmental causes, e.g., inadequately tested nutrient bioavailability of fortifi ed foods, beverages, and supplements; inappropriate marketing of fortifi ed foods/beverages/supplements as a substitute for natural food source of nutrient(s) Decreased ability to consume sufficient amount of a mineral (s)

INADEQUATE* MINERAL INTAKE (SPECIFY) / Intake mineral tertentu tidak adekuat (NI-5.10.1)
Biochemical Data Calcium: bone mineral content (BMC) below the young adult mean. Hypocalciuria, serum 25(OH)D < 32 ng/mL Phosphorus < 2.6 mg/dL (0.84 mmol/L) Magnesium <1.8 mg/dL (0.7 mmol/L) Iron: hemoglobin < 13 g/L (2 mmol/L) (males); < 12 g/L (1.86 mmol/L) (females) Iodine: urinary excretion < 100 g/L (788 nmol/L) Copper, serum copper < 64 g/dL (10 mol/L) Anthropometric: Height loss Clinical: Calcium: diminished bone mineral density, hypertension, obesity

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INADEQUATE* MINERAL INTAKE (SPECIFY) / Intake mineral tertentu tidak adekuat (NI-5.10.1)
Dietary Insufficient mineral intake from diet compared to recommended intake: Food avoidance and/or elimination of whole food group(s) from diet Lack of interest in food Inappropriate food choices and/or chronic dieting behavior Vitamin/mineral defi ciency Client History Conditions associated with a diagnosis or treatment, e.g., malabsorption as a result of celiac disease, short bowel syndrome, infl ammatory bowel disease, or post-menopausal women without estrogen supplementation and increased calcium need Polycystic ovary syndrome, premenstrual syndrome, kidney stones, colon polyps Other signifi cant medical diagnoses and therapies Geographic latitude and history of Ultraviolet-B exposure/use of sunscreen Change in living environment/independence

EXCESSIVE MINERAL INTAKE (SPECIFY) / Kelebihan intake mineral tertentu (NI-5.10.2)

Definisi Higher intake of mineral from foods, supplements, medications or water, compared to established reference standards or recommendations based on physiological needs. Etiologi Food- and nutrition-related knowledge defi cit Harmful beliefs/attitudes about food, nutrition, and nutrition-related topics Food faddism Accidental oversupplementation Overconsumption of a limited variety of foods Lack of knowledge about management of diagnosed genetic disorder altering mineral homeostasis [hemochromatosis (iron), Wilsons disease (copper)] Lack of knowledge about management of diagnosed disease state requiring mineral restriction [cholestatic liver disease (copper and manganese), renal insuffi ciency (phosphorus, magnesium, potassium)]

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EXCESSIVE MINERAL INTAKE (SPECIFY) / Kelebihan intake mineral tertentu (NI-5.10.2)

Biochemical Data Changes in appropriate laboratory values, such as: TSH (iodine supplementation) HDL (zinc supplementation) Serum ferritin and transferrin saturation (iron overload) Hyperphosphatemia Hypermagnesemia Clinical: Hair and nail changes (selenium) Dietary: High intake of foods or supplements containing mineral compared to DRIs Anorexia (zinc supplementation) Client History GI disturbances (iron, magnesium, copper, zinc, selenium) Copper defi ciency anemia (zinc) Liver damage (copper, iron), enamel or skeletal fl uorosis (fl uoride)

Tambahan diagnosa sub class: Multi nutrient (5.11) (IDNT 2011)

Predicted suboptimal nutrient intake (specify) /

Prediksi intake zat gizi tertentu tidak optimal (NI5.11.1)** Predicted excessive nutrient intake (specify) / Prediksi kelebihan intake zat gizi tertentu (NI5.11.1)**

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Discussion

referensi
Referensi American Dietetic Association (2011). International Dietetics and Nutrition Terminology (IDNT) Reference Manual - Standardize Languaged for The Nutritional care Process. Chicago, IL 60606-6995, American Dietetic Association.

Special thanks for : Inggita K, for preparing PPT

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